|
PR ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ
|
Professional
|
Both
|
$4,697.56
|
|
|
Service Code
|
HCPCS 24362
|
| Min. Negotiated Rate |
$882.16 |
| Max. Negotiated Rate |
$2,835.52 |
| Rate for Payer: Cash Price |
$1,266.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,260.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,134.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,134.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,197.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,197.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,260.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,260.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$945.17
|
| Rate for Payer: Healthfirst Commercial |
$1,260.23
|
| Rate for Payer: Healthfirst Essential Plan |
$2,835.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,197.22
|
| Rate for Payer: Healthfirst QHP |
$1,260.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$882.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,260.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,071.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$882.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,260.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$945.17
|
| Rate for Payer: SOMOS Essential |
$945.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,260.23
|
|
|
PR ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL
|
Professional
|
Both
|
$3,618.23
|
|
|
Service Code
|
HCPCS 27443
|
| Min. Negotiated Rate |
$681.91 |
| Max. Negotiated Rate |
$2,191.86 |
| Rate for Payer: Cash Price |
$978.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$974.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$876.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$876.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$925.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$974.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$925.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$974.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$974.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$730.62
|
| Rate for Payer: Healthfirst Commercial |
$974.16
|
| Rate for Payer: Healthfirst Essential Plan |
$2,191.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.45
|
| Rate for Payer: Healthfirst QHP |
$974.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$681.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$974.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$828.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$681.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$974.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$730.62
|
| Rate for Payer: SOMOS Essential |
$730.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$974.16
|
|
|
PR ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS
|
Professional
|
Both
|
$3,669.40
|
|
|
Service Code
|
HCPCS 25447
|
| Min. Negotiated Rate |
$667.49 |
| Max. Negotiated Rate |
$2,145.49 |
| Rate for Payer: Cash Price |
$994.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$953.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$858.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$858.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$905.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$953.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$905.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$953.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$953.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$715.16
|
| Rate for Payer: Healthfirst Commercial |
$953.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,145.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$905.87
|
| Rate for Payer: Healthfirst QHP |
$953.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$667.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$953.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$810.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$667.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$953.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.16
|
| Rate for Payer: SOMOS Essential |
$715.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$953.55
|
|
|
PR ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS
|
Professional
|
Both
|
$5,660.55
|
|
|
Service Code
|
HCPCS 27447
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$3,408.97 |
| Rate for Payer: Cash Price |
$1,522.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,515.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,363.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,363.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,439.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,515.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,439.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,515.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,515.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,136.33
|
| Rate for Payer: Healthfirst Commercial |
$1,515.10
|
| Rate for Payer: Healthfirst Essential Plan |
$3,408.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,439.35
|
| Rate for Payer: Healthfirst QHP |
$1,515.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,060.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,515.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,287.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,060.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,515.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,136.33
|
| Rate for Payer: SOMOS Essential |
$1,136.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,515.10
|
|
|
PR ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT
|
Professional
|
Both
|
$5,060.83
|
|
|
Service Code
|
HCPCS 27446
|
| Min. Negotiated Rate |
$950.96 |
| Max. Negotiated Rate |
$3,056.65 |
| Rate for Payer: Cash Price |
$1,365.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,358.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,222.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,222.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,290.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,358.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,290.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,358.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,358.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,018.88
|
| Rate for Payer: Healthfirst Commercial |
$1,358.51
|
| Rate for Payer: Healthfirst Essential Plan |
$3,056.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,290.58
|
| Rate for Payer: Healthfirst QHP |
$1,358.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$950.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,358.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,154.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$950.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,358.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,018.88
|
| Rate for Payer: SOMOS Essential |
$1,018.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,358.51
|
|
|
PR ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT
|
Professional
|
Both
|
$3,655.51
|
|
|
Service Code
|
HCPCS 27441
|
| Min. Negotiated Rate |
$688.25 |
| Max. Negotiated Rate |
$2,212.22 |
| Rate for Payer: Cash Price |
$986.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$983.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$884.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$884.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$934.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$983.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$934.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$983.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$983.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$737.41
|
| Rate for Payer: Healthfirst Commercial |
$983.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,212.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$934.05
|
| Rate for Payer: Healthfirst QHP |
$983.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$688.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$983.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$835.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$688.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$983.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$737.41
|
| Rate for Payer: SOMOS Essential |
$737.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$983.21
|
|
|
PR ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT
|
Professional
|
Both
|
$2,792.86
|
|
|
Service Code
|
HCPCS 26531
|
| Min. Negotiated Rate |
$530.54 |
| Max. Negotiated Rate |
$1,705.32 |
| Rate for Payer: Cash Price |
$758.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$757.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$682.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$682.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$720.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$757.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$720.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$757.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$757.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$568.44
|
| Rate for Payer: Healthfirst Commercial |
$757.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,705.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$720.02
|
| Rate for Payer: Healthfirst QHP |
$757.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$530.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$757.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$644.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$530.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$757.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$568.44
|
| Rate for Payer: SOMOS Essential |
$568.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$757.92
|
|
|
PR ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT
|
Professional
|
Both
|
$4,433.42
|
|
|
Service Code
|
HCPCS 21240
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$2,695.16 |
| Rate for Payer: Cash Price |
$1,196.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,197.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,078.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,078.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,137.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,197.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,137.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,197.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,197.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$898.39
|
| Rate for Payer: Healthfirst Commercial |
$1,197.85
|
| Rate for Payer: Healthfirst Essential Plan |
$2,695.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,137.96
|
| Rate for Payer: Healthfirst QHP |
$1,197.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$838.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,197.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,018.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$838.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,197.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$898.39
|
| Rate for Payer: SOMOS Essential |
$898.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,197.85
|
|
|
PR ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT
|
Professional
|
Both
|
$7,054.53
|
|
|
Service Code
|
HCPCS 21243
|
| Min. Negotiated Rate |
$1,289.25 |
| Max. Negotiated Rate |
$4,144.03 |
| Rate for Payer: Cash Price |
$1,916.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,841.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,657.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,657.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,749.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,841.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,749.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,841.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,841.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,381.34
|
| Rate for Payer: Healthfirst Commercial |
$1,841.79
|
| Rate for Payer: Healthfirst Essential Plan |
$4,144.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,749.70
|
| Rate for Payer: Healthfirst QHP |
$1,841.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,289.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,841.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,565.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,289.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,841.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,381.34
|
| Rate for Payer: SOMOS Essential |
$1,381.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,841.79
|
|
|
PR ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS
|
Professional
|
Both
|
$5,145.56
|
|
|
Service Code
|
HCPCS 25446
|
| Min. Negotiated Rate |
$969.66 |
| Max. Negotiated Rate |
$3,116.77 |
| Rate for Payer: Cash Price |
$1,390.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,385.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,246.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,246.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,315.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,385.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,315.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,385.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,385.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,038.92
|
| Rate for Payer: Healthfirst Commercial |
$1,385.23
|
| Rate for Payer: Healthfirst Essential Plan |
$3,116.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,315.97
|
| Rate for Payer: Healthfirst QHP |
$1,385.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$969.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,385.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,177.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$969.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,385.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,038.92
|
| Rate for Payer: SOMOS Essential |
$1,038.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,385.23
|
|
|
PR ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ
|
Professional
|
Both
|
$3,727.08
|
|
|
Service Code
|
HCPCS 25332
|
| Min. Negotiated Rate |
$704.29 |
| Max. Negotiated Rate |
$2,263.79 |
| Rate for Payer: Cash Price |
$1,008.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,006.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$905.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$905.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$955.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,006.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$955.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,006.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,006.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$754.60
|
| Rate for Payer: Healthfirst Commercial |
$1,006.13
|
| Rate for Payer: Healthfirst Essential Plan |
$2,263.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$955.82
|
| Rate for Payer: Healthfirst QHP |
$1,006.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$704.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,006.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$855.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$704.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,006.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$754.60
|
| Rate for Payer: SOMOS Essential |
$754.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,006.13
|
|
|
PR ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$4,290.62
|
|
|
Service Code
|
HCPCS 29888
|
| Min. Negotiated Rate |
$804.50 |
| Max. Negotiated Rate |
$2,585.90 |
| Rate for Payer: Cash Price |
$1,157.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,149.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,034.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,034.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,091.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,149.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,091.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,149.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,149.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$861.97
|
| Rate for Payer: Healthfirst Commercial |
$1,149.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,585.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,091.83
|
| Rate for Payer: Healthfirst QHP |
$1,149.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$804.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,149.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$976.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$804.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,149.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$861.97
|
| Rate for Payer: SOMOS Essential |
$861.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,149.29
|
|
|
PR ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ
|
Professional
|
Both
|
$5,408.17
|
|
|
Service Code
|
HCPCS 29889
|
| Min. Negotiated Rate |
$1,018.34 |
| Max. Negotiated Rate |
$3,273.23 |
| Rate for Payer: Cash Price |
$1,462.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,454.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,309.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,309.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,382.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,454.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,382.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,454.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,454.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,091.08
|
| Rate for Payer: Healthfirst Commercial |
$1,454.77
|
| Rate for Payer: Healthfirst Essential Plan |
$3,273.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,382.03
|
| Rate for Payer: Healthfirst QHP |
$1,454.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,018.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,454.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,236.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,018.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,454.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,091.08
|
| Rate for Payer: SOMOS Essential |
$1,091.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,454.77
|
|
|
PR ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX
|
Professional
|
Both
|
$2,735.18
|
|
|
Service Code
|
HCPCS 29892
|
| Min. Negotiated Rate |
$520.31 |
| Max. Negotiated Rate |
$1,672.42 |
| Rate for Payer: Cash Price |
$746.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$743.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$668.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$668.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$706.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$743.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$706.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$743.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$743.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$557.48
|
| Rate for Payer: Healthfirst Commercial |
$743.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,672.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$706.13
|
| Rate for Payer: Healthfirst QHP |
$743.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$520.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$743.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$631.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$520.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$743.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$557.48
|
| Rate for Payer: SOMOS Essential |
$557.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$743.30
|
|
|
PR ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$3,449.04
|
|
|
Service Code
|
HCPCS 29855
|
| Min. Negotiated Rate |
$650.52 |
| Max. Negotiated Rate |
$2,090.95 |
| Rate for Payer: Cash Price |
$932.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$929.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$836.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$836.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$882.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$929.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$882.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$929.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$696.98
|
| Rate for Payer: Healthfirst Commercial |
$929.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,090.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$882.84
|
| Rate for Payer: Healthfirst QHP |
$929.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$650.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$929.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$789.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$650.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$696.98
|
| Rate for Payer: SOMOS Essential |
$696.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.31
|
|
|
PR ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR
|
Professional
|
Both
|
$4,389.39
|
|
|
Service Code
|
HCPCS 29856
|
| Min. Negotiated Rate |
$826.37 |
| Max. Negotiated Rate |
$2,656.19 |
| Rate for Payer: Cash Price |
$1,184.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,180.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,062.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,062.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,121.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,180.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,121.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$885.40
|
| Rate for Payer: Healthfirst Commercial |
$1,180.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,656.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,121.50
|
| Rate for Payer: Healthfirst QHP |
$1,180.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$826.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,180.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,003.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$826.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,180.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$885.40
|
| Rate for Payer: SOMOS Essential |
$885.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,180.53
|
|
|
PR ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT
|
Professional
|
Both
|
$2,909.31
|
|
|
Service Code
|
HCPCS 29891
|
| Min. Negotiated Rate |
$555.82 |
| Max. Negotiated Rate |
$1,786.57 |
| Rate for Payer: Cash Price |
$797.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$794.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$714.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$714.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$754.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$794.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$754.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$794.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$794.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$595.52
|
| Rate for Payer: Healthfirst Commercial |
$794.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,786.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$754.33
|
| Rate for Payer: Healthfirst QHP |
$794.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$555.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$794.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$674.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$555.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$794.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$595.52
|
| Rate for Payer: SOMOS Essential |
$595.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$794.03
|
|
|
PR ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG
|
Professional
|
Both
|
$3,581.62
|
|
|
Service Code
|
HCPCS 29862
|
| Min. Negotiated Rate |
$674.63 |
| Max. Negotiated Rate |
$2,168.46 |
| Rate for Payer: Cash Price |
$974.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$963.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$867.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$867.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$915.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$963.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$915.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$963.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$963.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$722.82
|
| Rate for Payer: Healthfirst Commercial |
$963.76
|
| Rate for Payer: Healthfirst Essential Plan |
$2,168.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$915.57
|
| Rate for Payer: Healthfirst QHP |
$963.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$674.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$963.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$819.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$674.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$963.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$722.82
|
| Rate for Payer: SOMOS Essential |
$722.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$963.76
|
|
|
PR ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX
|
Professional
|
Both
|
$2,927.02
|
|
|
Service Code
|
HCPCS 29879
|
| Min. Negotiated Rate |
$553.07 |
| Max. Negotiated Rate |
$1,777.72 |
| Rate for Payer: Cash Price |
$792.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$790.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$711.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$711.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$750.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$790.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$750.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$790.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$790.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$592.58
|
| Rate for Payer: Healthfirst Commercial |
$790.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,777.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$750.60
|
| Rate for Payer: Healthfirst QHP |
$790.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$553.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$790.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$671.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$553.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$790.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$592.58
|
| Rate for Payer: SOMOS Essential |
$592.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$790.10
|
|
|
PR ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG
|
Professional
|
Both
|
$2,749.11
|
|
|
Service Code
|
HCPCS 29877
|
| Min. Negotiated Rate |
$518.91 |
| Max. Negotiated Rate |
$1,667.92 |
| Rate for Payer: Cash Price |
$744.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$741.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$667.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$704.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$741.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$704.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$741.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$555.98
|
| Rate for Payer: Healthfirst Commercial |
$741.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,667.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$704.24
|
| Rate for Payer: Healthfirst QHP |
$741.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$518.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$741.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$630.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$518.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$741.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$555.98
|
| Rate for Payer: SOMOS Essential |
$555.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$741.30
|
|
|
PR ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION
|
Professional
|
Both
|
$2,824.99
|
|
|
Service Code
|
HCPCS 29886
|
| Min. Negotiated Rate |
$534.61 |
| Max. Negotiated Rate |
$1,718.39 |
| Rate for Payer: Cash Price |
$765.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$763.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$687.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$687.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$725.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$763.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$725.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$763.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$763.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$572.80
|
| Rate for Payer: Healthfirst Commercial |
$763.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,718.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$725.54
|
| Rate for Payer: Healthfirst QHP |
$763.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$534.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$763.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$649.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$534.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$763.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$572.80
|
| Rate for Payer: SOMOS Essential |
$572.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$763.73
|
|
|
PR ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG
|
Professional
|
Both
|
$3,350.52
|
|
|
Service Code
|
HCPCS 29885
|
| Min. Negotiated Rate |
$633.51 |
| Max. Negotiated Rate |
$2,036.27 |
| Rate for Payer: Cash Price |
$907.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$905.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$814.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$814.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$859.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$905.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$859.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$905.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$905.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$678.76
|
| Rate for Payer: Healthfirst Commercial |
$905.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,036.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$859.76
|
| Rate for Payer: Healthfirst QHP |
$905.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$633.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$905.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$769.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$633.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$905.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$678.76
|
| Rate for Payer: SOMOS Essential |
$678.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$905.01
|
|
|
PR ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ
|
Professional
|
Both
|
$3,337.18
|
|
|
Service Code
|
HCPCS 29887
|
| Min. Negotiated Rate |
$631.06 |
| Max. Negotiated Rate |
$2,028.40 |
| Rate for Payer: Cash Price |
$904.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$901.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$811.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$811.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$856.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$901.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$856.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$901.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$901.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$676.13
|
| Rate for Payer: Healthfirst Commercial |
$901.51
|
| Rate for Payer: Healthfirst Essential Plan |
$2,028.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$856.43
|
| Rate for Payer: Healthfirst QHP |
$901.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$631.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$901.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$766.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$631.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$901.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$676.13
|
| Rate for Payer: SOMOS Essential |
$676.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$901.51
|
|
|
PR ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING
|
Professional
|
Both
|
$2,489.59
|
|
|
Service Code
|
HCPCS 29880
|
| Min. Negotiated Rate |
$470.05 |
| Max. Negotiated Rate |
$1,510.88 |
| Rate for Payer: Cash Price |
$674.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$671.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$604.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$604.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$637.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$671.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$637.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$671.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$671.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$503.62
|
| Rate for Payer: Healthfirst Commercial |
$671.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,510.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$637.92
|
| Rate for Payer: Healthfirst QHP |
$671.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$470.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$671.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$570.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$470.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$671.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$503.62
|
| Rate for Payer: SOMOS Essential |
$503.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$671.50
|
|
|
PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG
|
Professional
|
Both
|
$2,394.00
|
|
|
Service Code
|
HCPCS 29881
|
| Min. Negotiated Rate |
$453.01 |
| Max. Negotiated Rate |
$1,456.11 |
| Rate for Payer: Cash Price |
$649.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$647.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$582.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$582.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$614.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$647.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$614.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$647.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$647.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$485.37
|
| Rate for Payer: Healthfirst Commercial |
$647.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,456.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$614.80
|
| Rate for Payer: Healthfirst QHP |
$647.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$453.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$647.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$550.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$453.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$647.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$485.37
|
| Rate for Payer: SOMOS Essential |
$485.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$647.16
|
|
